| Objective:Statistics of the clinical data of severe acute pancreatitis(SAP),by comparing the data of infected pancreatic necrosis(IPN)with that of non-infected pancreatic necrosis,to find early risk factors of IPN.At the same time,explore the value of neutrophil-lymphocyte ratio(NLR),procalcitonin(PCT)in combined with modified CT severity index score(MCTSI)in the early prediction of IPN.Methods:Clinical data of 324 patients with SAP admitted to the Affiliated Hospital of Qingdao University and the Affiliated Hospital of Jining Medical College from September 2018 to August 2020 were retrospectively analyzed,including gender,age,body mass index(BMI),and other general clinical data and causes,complications,fasting time,parenteral nutrition support treatment time.At the same time,the dynamic changes of NLR,PCTand MCTSI score of the patients within 7 days after admission were analyzed.According to the occurrence of IPN,the patients were divided into infected group(144 cases)and non-infected group(180 cases).Using SPSS26.0 software to analyze data,accord with normal distribution measurement data to mean + /-standard deviation((?) + s)said,two two compared by t test,repetitive measure analysis of variance with repeated measurement data,non-normal distribution data to the median and interquartile range M(P25,P75)said that the rank and inspection.Enumeration data was expressed as the number of cases(%),and the chi-square test(χ~2)was used.Multivariate logistic regression analysis was performed on the indicators with statistical significance,and R0 C curve was drawn to evaluate the diagnostic efficacy of each indicator separately and in combination for secondary infection in SAP.Result:1.Among the 324 cases of SAP,biliary tract disease and hyperlipidemia were the main etiology,and IPN occurred in 144 cases,with an incidence rate of44.4%.Eighty-nine strains of bacteria were detected,of which G-bacillus was the main strain(50%),followed by G+ coccus(37.7%)and 9 strains of fungi.Patients in the infected group had longer hospital stays and a higher mortality rate than those in the non-infected group.2.There was no significant difference in gender,age,etiology and complications between the two groups(P>0.05).BMI,fasting time,duration of intravenous nutritional support treatment,MCTSI,NLR and PCT on the first,fourth and seventh day of admission were higher in the infected group than in the non-infected group,with statistical significance(P<0.05),multiple logistic regression analysis showed that a longer time of diet restriction,intravenous nutritional support treatment,as well as the increase of NLR,PCT and MCTSI were correlated with the incidence of IPN(P<0.05),while the P value of BMI was >0.05.3.Based on the modeling of NLR,PCT and MCTSI on the 7th day of admission,multiple logistic regression analysis showed that the increase of NLR,PCT and MCTSI was correlated with the occurrence of IPN(P<0.05).The area under receiver operating characteristic curve(AUC)of NLR,PCT and MCTSI were 0.878,0.868 and 0.852,the optimal cutoff values of the three were 5.92,0.18ng/ml and 5 points.When the three were combined,the predictive efficiency of IPN was better,the AUC was 0.921,the sensitivity was 97.22%,and the specificity was 78.3%.Conclusion:1、The dynamic changes of NLR,PCT and MCSI have good early prediction value for SAP secondary IPN,and the combined application of the three has higher prediction efficiency.2 、 Longer time of dietary abstainance,intravenous nutritional support treatment,continuous increase of NLR,PCT and MCTSI are the high risk factors of secondary IPN in SAP patients.3 、 Monitoring the dynamic changes of all indicators combined with the clinical manifestations of patients can help clinicians to accurately judge the condition,optimize the treatment plan in time and improve the prognosis of patients. |
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